Did you receive a notice that you or your healthcare organization is under investigation for potential healthcare fraud? Then it is important for you to get in touch with a healthcare fraud attorney immediately. An experienced attorney can provide invaluable guidance and representation to you in such a case. It will help you to protect your interests, rights, and livelihood throughout the investigation process.
Understand the Allegations
The first thing an attorney can help with is gaining clarity on exactly what allegations have been made against you and the entity that is investigating (e.g. Department of Justice, Office of Inspector General, and FBI). They will review any letters, subpoenas, or other communications you have received to determine the scope of alleged violations.
Whether accusations involve submitting false claims, violating Anti-Kickback statutes, misusing billing codes, or other fraudulent activities – having legal counsel who comprehends the nuances is key.
Assemble a Defense Strategy
Every healthcare fraud probe is unique, so your legal team will develop a customized defense strategy based on the particular allegations made and entities/regulations involved. This starts with reviewing your billing, coding, and other healthcare practices to identify any inappropriate conduct versus simply accidental errors.
Your attorney may also initiate internal audits, gather testimony, and start constructing legal arguments to refute or mitigate the allegations. The goal is building an overall defense case to demonstrate good faith efforts in compliance.
Respond Appropriately to Investigators
When government agents come knocking or start requesting documents, having an attorney ensures you respond appropriately without accidentally self-incriminating. Your lawyer will manage interactions with investigators, conveying that you take allegations seriously while also protecting sensitive information.
They can identify requests that might exceed investigator legal authority and negotiate what you are required to produce. Your attorney can also prepare you for any interviews or even handle questioning on your behalf.
Explore Settlement Options
If some allegations appear legitimate, your attorney may advise negotiating a settlement instead of fighting charges in court. They can speak with prosecutors on your behalf to secure a favorable plea deal or enter you into a “diversion program” to avoid criminal/civil prosecution.
This may require paying fines, admitting limited fault, instituting new compliance programs, or submitting to monitoring for a period. Though unpleasant, settling may avert massive penalties down the road. A lawyer who is experienced in such agreements can best advise if this route is suitable.
Defend in Administrative Hearings
Certain cases don’t necessitate court but will involve defending against charges in an administrative hearing before an appointed judge. Here again your attorney will protect rights by presenting counter evidence, questioning witnesses, and even highlighting mitigating factors like prior good faith compliance. If sanctions result, an attorney can still negotiate the least damaging outcome or file administrative appeals as warranted.
Navigate Parallel Civil Litigation
Be aware government fraud allegations often prompt follow-on civil lawsuits by private whistleblowers hoping to secure a portion of recovered funds. But an attorney can file motions to appropriately pause civil action while the criminal investigation runs its course. This prevents overlap that could force you revealing defense strategy. Later, your legal team can work to resolve civil litigation consistently with the criminal case outcome.
Explore Lawful Ways to Halt Prosecution
Experienced counsel – especially former healthcare fraud prosecutors themselves – may know procedural maneuvers that can halt unfair prosecution in its tracks. Options might include moving to dismiss charges due to unconstitutional vagueness, demonstrating prosecutorial misconduct, excluding improper evidence, or even negotiating global non-prosecution agreements. While a long-shot remedy, well-versed attorneys recognize how to leverage such rarely utilized tools when viable.
Final Words
Facing fraud accusations can be enormously stressful, making competent legal guidance invaluable. Your attorney serves as an objective third party to explain implications of different actions and guide decision making. Their top priority is shielding you from worst case scenarios like exclusion from federal healthcare programs or even imprisonment. With an expert advisor at your side, you can take comfort knowing someone is fully focused on protecting your interests.
